Impact of DCS-facilitated cue exposure therapy on brain activation to cocaine
cues in cocaine dependence.
Author(s): Prisciandaro JJ(1), Myrick H, Henderson S, McRae-Clark AL, Santa Ana EJ, Saladin
ME, Brady KT.
Affiliation(s): Author information:
(1)Medical University of South Carolina, Department of Psychiatry and Behavioral
Sciences, Clinical Neuroscience Division, 67 President Street, MSC861,
Charleston, SC 29425, United States. priscian@musc.edu
Publication date & source: 2013, Drug Alcohol Depend. , 132(1-2):195-201
BACKGROUND: The development of addiction is marked by a pathological associative
learning process that imbues incentive salience to stimuli associated with drug
use. Recent efforts to treat addiction have targeted this learning process using
cue exposure therapy augmented with d-cycloserine (DCS), a glutamatergic agent
hypothesized to enhance extinction learning. To better understand the impact of
DCS-facilitated extinction on neural reactivity to drug cues, the present study
reports fMRI findings from a randomized, double-blind, placebo-controlled trial
of DCS-facilitated cue exposure for cocaine dependence.
METHODS: Twenty-five participants completed two MRI sessions (before and after
intervention), with a cocaine-cue reactivity fMRI task. The intervention
consisted of 50mg of DCS or placebo, combined with two sessions of cocaine cue
exposure and skills training.
RESULTS: Participants demonstrated cocaine cue activation in a variety of brain
regions at baseline. From the pre- to post-study scan, participants experienced
decreased activation to cues in a number of regions (e.g., accumbens, caudate,
frontal poles). Unexpectedly, placebo participants experienced decreases in
activation to cues in the left angular and middle temporal gyri and the lateral
occipital cortex, while DCS participants did not.
CONCLUSIONS: Three trials of DCS-facilitated cue exposure therapy for cocaine
dependence have found that DCS either increases or does not significantly impact
response to cocaine cues. The present study adds to this literature by
demonstrating that DCS may prevent extinction to cocaine cues in temporal and
occipital brain regions. Although consistent with past research, results from the
present study should be considered preliminary until replicated in larger
samples.
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